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Events
Entry Stats
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Levels
Calendar
Points & Awards
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Volunteer
News
Forms & Docs
Contact
Kimberly Smith Clinic Registration
Please select which options you would like to enter: 30 minute private or 45 min semi-private flat lessons; 1 hour gridwork, or 1 hour course lesson with course walk. Please specify the level in which rider is wanting to lesson – Tadpole, X Rails, Green, Advanced Green, Beginner Novice, Novice, Training, Modified, Prelim. Jumping Groups will not exceed 5 participants.
Rider Info
Membership
(Required)
None
BREA
Rider Name
(Required)
First
Last
Address
Street Address
Address Line 2
City
State
Zip Code
Phone
(Required)
Email
(Required)
Horse Info
Horse Name
(Required)
Horse Gender
(Required)
Stallion
Mare
Gelding
Owner Same as Rider?
Yes
No
Owner Name
Entry
Entry Fees
Non-Members
Flat: 30 min. private
Flat: 45 min. semi-private
Gridwork
Stadium course w/course walk
BREA Members
Flat: 30 min. private
Flat: 45 min semi-private
Gridwork
Stadium course w/course walk
Level
Tadpole (10")
Cross rails (18")
Green (2')
Advanced Green (2'3")
Beg. Novice (2'7")
Novice (2'11")
Training (3'3")
Modified (3'5")
Prelim (3'7")
Riding Level
What are you currently working on, and what are you working towards. Anything you would like to work on with Kim during the clinic?
Coggins
Coggins Date
(Required)
MM slash DD slash YYYY
Coggins Accession #
(Required)
If a coggins is not submitted electronically, you must bring a hard copy of the coggins to the show for the secretary to keep.
Coggins Upload
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Waivers
Waivers can be found here:
USEA Waiver
BREA Waiver (print and email back)
BREA Waiver (complete & submit online)
For print waivers, click the link and print, then scan and attach below.
Waiver Upload
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
USEF Release Upload
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Total
*Bring Check day of Clinic (if bringing cash, please bring exact amount, making change will not be available) *Mail Checks to Casey Moyer; 3199 Bradshaw Road, Elliston, VA, 24087No refunds after closing day! No shows - Full amount will still be owed.
Notes to Organizer
